Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Shipwreck

“A shipwreck…she has everything wrong with her…no one documents that this is a major factor in her recovery from injury.”

“There are two significant problems as I see it, and they relate to far too many patients, including ourselves:

1. Years ago, if you did not have health insurance, you paid out of pocket. Many would argue that you value things more when you pay for them. Nonetheless, most of us expect that by one means or another, we shall have little to no expense for health care, and we can change providers at will within an approved network.

A close relationship with a provider is less common in this environment, because we can take our symptoms, our insurance card, and our co-pay, and seek episodic care. With regard to health and recovery under workers’ compensation, the situation is even more problematic:

The “shipwreck” patient does not seek the provider, has no prior relationship with him/her, does not pay for health care delivery, and is often transported to the appointment. In exchange for having no control over their choice of physician, injured workers have no out of pocket expense; even time is not a budgetary factor if there is no activity to compete with the appointment. Injury has changed the parameters with regard to cost, effort, and duration/extent of the relationship with the health care provider.

2. In America in general, we have maladaptive health behaviors that dominate the lives of many. Poor diet, inactivity, destructive habits, and a genetic predisposition to chronic diseases results in unhealthy individuals getting injured.

The pre-injury health habits of many injured workers are frankly deplorable. Hobbies may be limited to outdoors, field and stream, and interaction with nature. Bambi is a big player in this.

The “shipwreck” patient is told to quit smoking prior to surgery. The patient is told not to mix medication with alcohol. And the patient is told to engage is reasonable daily exercise, limit certain foods, and comply with medication for hypertension, diabetes, and cholesterol. Treaters presume that warnings and admonitions will insure full participation in the recovery process. It does not.

Few patients understand how any of their dysfunctional behaviors disrupt recovery: why is alcohol an issue, how does smoking impact surgery, and how does diabetes affect healing? Beginning at the age of two, we learn to ask “why” we must do anything.

We must accept that in the absence of a healthy baseline, our patients require significant education if compliance is to be obtained.”